7. Tatalaksana Medik Pasien Stroke 2019 - Askep Dasar Stroke (1).pdf

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1. TATALAKSANA MEDIK PADA PASIEN STROKE
dr. Ita Muharram Sari, Sp.S
Divisi Neuroemergensi & Neurointensif
Ketua Tim Stroke
RS Pusat Otak Nasional

2. MANAJEMEN STROKE AKUT
Empat hal utama dalam penatalaksanaan stroke akut di rumah sakit:
1.Penanganan kondisi fisiologi pasien.
2.Terapi spesifik yang berhubungan langsung dengan berbagai
patogenesis stroke. (rekanalisasi, neuroproteksi)
3.Profilaksis dan penanganan komplikasi.
4.Rehabilitasi secepatnya.
2
Guideline Stroke Perdossi, 2011
7/29/2019Pelatihan Askep Stroke Dasar 2019

3. PENANGANAN STROKE PRA HOSPITAL
•Deteksi Dini 95% kasus di luar RS
•Pengiriman Pasien (ambulans /transportasi udara)
•Fasilitas ideal ambulans : personel terlatih, peralatan & obat
resusitasi, mesin EKG, glucometer, pulse oximeter
3
Guideline Stroke Perdossi, 2011
7/29/2019Pelatihan Askep Stroke Dasar 2019

4. PENANGANAN STROKE PRA HOSPITAL
•Beberapa hal yg harus diperhatikan petugas pelayanan ambulans :
•Jangan terlambat membawa ke RS yang tepat
•Jangan memberikan cairan berlebihan kecuali pada pasien syok &
hipotensi
•Hindari pemberian cairan glukosa/dekstrose, kecuali hipoglikemia
•Hindari hipotensi, hipoventilasi
•Catat waktu onset serangan
•Memanfaatkan jaringan pelayanan stroke komprehensif, yaitu IGD, stroke
unit atau ICU sebagai tujuan penanganan definitif pasien stroke
4
Guideline Stroke Perdossi, 2011
7/29/2019Pelatihan Askep Stroke Dasar 2019

5. PENATALAKSANAAN UMUM STROKE AKUT
•Stabilisasi jalan nafas & Pernafasan  Tx O
2 pada pasien hipoksia (SaO2 < 95%)
•Stabilisasi hemodinamik  cairan kristaloid, CVC, optimalisasi tekanan darah
•Pengendalian Peninggian Tekanan Intra Kranial
•Pengendalian Kejang, Suhu Tubuh, kadar glukosa darah
•Nutrisi enteral 1x24 jam, evaluasi disfagia
•Pencegahan & Penanganan Komplikasi  aspirasi, malnutrisi, DVT, emboli paru,
dekubitus
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Guideline Stroke Perdossi, 2011
7/29/2019Pelatihan Askep Stroke Dasar 2019

6. 6
TIME is BRAIN
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7. 7
•Brain = 2 % BB, O
2 demand 20% CO
•Average neurons in human forebrain :
22 billion
•Ischemic stroke : 1.9 million neurons,
14 billion synapses & 12 km (7.5
miles) of myelinated fibers are
destroyed /minute
7/29/2019Pelatihan Askep Stroke Dasar 2019
Ischemic Stroke

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9. PENATALAKSANAAN KHUSUS STROKE ISKEMIK
•0-4.5 hours
Trombolisis iv rtPA (alteplase)
•0-24 hours
Endovascular treatment (in addition to iv tPA)
(Mechanical Thrombectomy)
9
Powers WJ, 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the AHA/ASA, Stroke
2018 ; 49: e46-e99
7/29/2019Pelatihan Askep Stroke Dasar 2019

10. TROMBOLISIS
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12. RTPA IN NBC
1022
1250
1963
365
431
469
1387
1681
2432
0
500
1000
1500
2000
2500
3000
2016 2017 2018
Number of stroke patients in NBC
Ischemic Stroke
ICH stroke
Total stroke patients
0
100
200
300
400
500
J a n F e b
M a r c h
A p r M a y J u n e J u l y A u g S e p t N o v N o v D e c
2018 (N=4755)
2017 (N=3614)
2016 (N=3194)
Admision patients from ER
2016 2017 2018
1 : 102 1 : 62.5 1:16
0.98 % 1,6% 6,27 %
10 20
123
rTPA
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13. PENATALAKSANAAN KHUSUS STROKE PIS
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Resiko : rebleeding, ongoing bleeding
Manajemen penanganan peningkatan tekanan
intrakranial
Konsultasi Bedah Saraf hidrosefalus,
evakuasi hematoma, dekompresi
7/29/2019Pelatihan Askep Stroke Dasar 2019

14. PENATALAKSANAAN KHUSUS STROKE PSA
•Caution : Thunderclap headache
•Evaluasi klinis : Grading Hunt & Hess
•Diagnosa : CT Angiografi
•Penanganan vasospasme cerebral triple H
(hypervolemic-hypertensive-hemodilution),
nimodipin
•Aneurisma : endovascular coiling / surgical
clipping
147/29/2019Pelatihan Askep Stroke Dasar 2019

15. ALGORITHM TREATMENT
ACUTE HYPERTENSIVE
RESPONSE
15
Qureshi AI, Acute Hypertensive Response in
Patients with Stroke, Circulation 2008;118:176-187
no other end-organ damage, such as:
- cardiac ischemia
-- acute heart failure
-- aortic dissection
- acute renal failure
15% during first 24
hours onset stroke
Powers WJ, 2018 Guidelines for the Early Management of Patients
With Acute Ischemic Stroke: A Guideline for Healthcare
Professionals From the AHA/ASA, Stroke 2018 ; 49: e46-e99
For ICH patients presenting with
SBP between 150 and 220
mmHg and without
contraindication to acute BP
treatment, acute lowering of
SBP to 140 mmHg is safe (Class
I; LoE A) and can be effective for
improving functional outcome
(Class IIa; LoE B)
Hemphilllll JC, Guidelines for the Management of
Spontaneous ICH , Stroke 2015;46;2032-2060
7/29/2019Pelatihan Askep Stroke Dasar 2019

16. ACUTE ISCHEMIC STROKE WITH TROMBOLYSIS
16
Powers WJ, 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the AHA/ASA,
Stroke 2018 ; 49: e46-e99
7/29/2019Pelatihan Askep Stroke Dasar 2019

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